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Reteplase in the
treatment of thrombosed hemodialysis grafts.
Falk
A, Guller J, Nowakowski FS, Mitty H, Teodorescu V, Uribarri J,
Vassalotti J.
Department of Radiology, Mount Sinai-NYU
Medical Center, One Gustave L. Levy Place, New York, New York
10029-6574, USA. [email protected]
PURPOSE: To
prospectively evaluate the efficacy and safety of reteplase with
percutaneous transluminal angioplasty (PTA) in the treatment of
thrombosed polytetrafluoroethylene hemodialysis arteriovenous grafts
(AVGs). MATERIALS AND METHODS: Forty-two patients were entered into the
study. Sixty-two procedures in 43 grafts were performed. One unit of
reteplase and 4,000 units of heparin were administered into the AVGs.
Routine venography and percutaneous transluminal angioplasty (PTA) was
then performed. Patients were transferred for hemodialysis immediately
after the procedure. RESULTS: Technical success was achieved in 92% of
the cases. Four cases involved intentional repeat thrombosis because of
poor outflow and/or need for a new graft site. Minor complications
occurred in 6.5% of the cases. No major complications occurred. The mean
procedure time for experienced versus less-experienced
interventionalists was significantly shorter (P <.001). Primary
patency rates were 50%, 34%, and 34% at 30, 90, and 180 days,
respectively. CONCLUSION: Reteplase in conjunction with heparin and PTA
is a safe and effective means of thrombolysis of AVGs. Its efficacy is
comparable to that of other available thrombolytic drugs.
PMID:
11698623 [PubMed - indexed for MEDLINE]
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